Low Back Pain
Thoracic Pain/Upper Back Pain
Thoracic pain occurs in the spine in the area between the neck and lower back. While the neck and lower back are designed to provide us with mobility, the thoracic spine is designed to be very strong and stable to allow us to stand upright and to protect the vital internal organs in the chest. The most common causes of upper back pain are muscular irritation and joint dysfunction however, it can be difficult to diagnose since referred pain from the organs can mimic pain.
Someone can injure their upper back when heavy carrying objects, throwing, bending or twisting the back in an incorrect manner. Sitting at a desk for a prolonged time can cause upper back muscles to tighten and become stiff. Upper back pain can even come from vigorous coughing or sneezing. Sometimes upper back pain is caused by scoliosis, a curve in the spine that has developed during the adolescent growth period. With scoliosis there is usually an imbalance of the muscles of the upper back. Physiotherapy treatment includes easeing the pain and also addressing the cause of the pain via a thorough neuromusculoskeletal assessment and a holistic approach to ergonomics and movement control, as well as addressing abnormalities eg scoliosis.
Low Back Pain
The presentation of Low Back Pain (LBP) can be extremely diverse from acute episodes where you feel unable to stand up straight, to an ongoing ache over many years, to referred pain going down the leg. It is because of this variety that it is essential that a physiotherapist fully assesses your condition to determine the appropriate course of treatment for your particular symptoms.
Disc Related Pain:
Throughout the spine there are discs between the vertebrae. These discs acts like shock absorbers and help to maintain a balanced distribution of forces within the spine. Each disc consists of a gel like centre, called the nucleus, and is surrounded by an outer protective layer called the annulus. Due to the nature of many of our professions and hobbies, the disc can be placed under repeated stress in certain positions and with repetitive movements. This can lead to a bulging of the disc, which can press on some of the surrounding structures producing pain. If there is compression on the nerve, you are likely to experience pins and needles or numbness down the leg. Also see sciatica.
Facet Joint Pain:
Each vertebra has two facet joints connecting to the level above and two to the level below. In a well conditioned back the facet joints slide on each other to allow us to move normally and without pain. When a facet joint becomes restricted in its ability to slide (due to injury/trauma) it can lead to LBP. The facet joints usually produce pain locally on one side, but if highly aggravated may refer pain into the leg.
Most patients broadly use the term sciatica when they have pain referring down the leg. The sciatic nerve is made up of a collection of nerves which merge together after exiting the spine and travel down the back of the leg and into the calf. Therefore, true sciatica is when this nerve is irritated and produces shooting pain into the back of the leg or calf. But in the back muscles, joints, ligaments and nerves can produce referred pain. That is why it is important for a physiotherapist to evaluate the condition and determine what the cause of the symptoms is and treat it accordingly.
Sacro-iliac Joint Pain
The Sacro-Iliac Joint can be located in the pelvis and is formed by the sacrum (the end of the spine) and the two iliac bones (pelvic bones). The SI-joints can be seen when viewing your back in the mirror – the SI-joints are underneath the two dimples beside the base of the lower back. Patients typically describe pain as low back pain, usually felt on one side and locally to the base of the spine and buttock area. It can commonly coexist with low back pain or hip problems, and patients often complain of pain when getting in or out of the car, turning over in bed, standing on one leg and climbing stairs. Pains attributable to the SI-J are often seen during and after pregnancy (see Pregnancy Related Low Back Pain). A thorough assessment by your physiotherapist will determine whether the SI-J, lumbar spine, hip joint or a combination of these are the reason for your symptoms.
Pregnancy Related Low Back Pain
Low Back Pain is a common condition in the third trimester of pregnancy. The expanding uterus shifts the centre of gravity and stretches out and weakens the abdominal muscles, changing the body’s posture and putting strain on the back. In addition, the extra weight the body is carrying means more work for the muscles and increased stress on the joints, which is why the back may feel worse at the end of the day.
Hormonal changes in pregnancy loosen the ligaments that attach your pelvic bones to your spine (see Sacro-Iliac Joint Pain). This can make you feel less stable and cause pain when you walk, stand, sit for long periods, roll over in bed, get out of a low chair or the tub, bending and climbing stairs.